KR20220039825A - Suture anchor construct and deployment device - Google Patents

Abstract

A soft suture anchor structure is provided for placement in or on tissue or bone. The anchor includes a pre-suture anchor having two ends positioned in a first direction in a pre-deployment configuration. In the deployed configuration, the two ends are positioned in a second direction different from the first direction. The suture anchor structure also includes a filament passing through the anchor at a plurality of passing positions, the filament changing direction at least once along a direction of a longitudinal axis of the anchor and forming at least one slack line. In the pre-deployed configuration, the filaments extend a first length between adjacent passage locations, and in the deployed configuration, the filaments extend a second length between adjacent passage locations. The second length is shorter than the first length. The suture anchor structure may be placed into the bone cavity with an inserter, anchor driver, or other placement device.

Description

SUTURE ANCHOR CONSTRUCT AND DEPLOYMENT DEVICE

This application has priority to U.S. Application No. 15/687040, filed on August 25, 2017, and U.S. Provisional Application No. 62/515023, filed June 5, 2017, and 62/517395, filed June 9, 2017; claim interests.

The present invention relates to a soft suture anchor construct for anchoring to the body, including extremities, and more particularly, to an all-suture anchor that can be secured within a narrow and shallow bony hole. ) with a flexible suture anchor structure.

Anchors are commonly used during surgical procedures to capture and hold an object, such as bone or soft tissue, at a desired attachment location. In particular, conventional anterior suture anchors are often used (as should be understood by those of ordinary skill in the art) to restore soft tissue to bone due to the particular advantages of soft materials comprising anterior suture anchors. To deploy a conventional anterior suture anchor, the anchor is inserted into a preformed hole in the bone. Sutures or filaments are woven through or secured around the anchor and extend from the anchor and out of the bone cavity. A suture or other filament is then used to repeat or attach to the soft tissue (or may already be attached). Thus, when the suture or other filament is tensioned, the soft tissue and anchor are pulled into the desired position relative to each other.

In many procedures involving soft tissue fixation in the extremity, it is necessary to have an anchor that can be used, for example, in a shallow hole with a narrow diameter due to the nature of the location of the procedure. Since any movement of the anchor from the shallow bone hole can completely release the anchor from the bone hole, the shallow bone hole should have good retention. Numerous factors can affect the retention of suture anchors. For example, external factors such as the type of tissue and the size of the bone hole affect the retention capacity of the suture anchor. Other factors related to the design of the anchor, such as size, shape and material composition, also affect retention. In addition, the method of placement of the suture anchor may also affect the retention of the suture anchor.

Conventional soft suture anchors to bony orifices are often too large and may extend out of the shallow and narrow bony foramen of the extremities. A misfit suture anchor can increase instability and cause irritation or damage to the tissue surrounding the exposed portion of the anchor. Attempts to address this problem include reducing the size of conventional suture anchors to fit within shallow and narrow bone openings. However, as the size of conventional suture anchors decreases, the anchors lose their retention and become unstable within the bone cavity.

In light of the above, the present inventors have identified and recognized a continuing need for a suture anchor that provides reliable retention when installed within a shallow, narrow bone cavity.

Related Art Section Disclaimer's Statement: To the extent that a particular patent/publication/product is discussed above in the description of the Related Art section or elsewhere in this disclosure, this discussion determines that the discussed patent/publication/product is for patent law purposes. It should not be considered as an admission that it is prior art of For example, some or all of the patents/publications/products discussed may not be early enough, may not reflect subjects developed in a sufficiently early time, and/or may not be sufficiently capable of leading to prior art for patent law purposes. it may not be To the extent that a particular patent/publication/product is discussed above within the description of the Related Art section and/or throughout this application, all of that description/disclosure is incorporated herein by reference in its entirety.

Embodiments of the present invention recognize that there are potential problems and/or disadvantages of conventional suture anchors (as discussed herein and above). For example, when conventional suture anchors are reduced to fit a narrow bone hole, the reduced suture anchor is more likely to be pulled out of the bone hole without losing retention. Accordingly, a need exists for an easy-to-use, flexible suture anchor structure having an anchor optimally positioned in the shallow and narrow aperture of the bone without compromising retention. Various embodiments of the present invention may be advantageous in that they may solve or reduce one or more of the potential problems and/or disadvantages discussed herein.

The present disclosure relates to the inventive construction, structure and resulting function of a flexible suture anchor construct. A soft anchor structure is provided for placement in, through, or against tissue or bone. The anchor may include a pre-suture anchor having two ends positioned in/opposite the first direction in the pre-deployment configuration. In the deployed configuration, the two ends are positioned in/opposite a second direction different from the first direction.

According to another embodiment, the soft suture anchor structure system further includes a filament having a first end and a second end. The filament passes through the anchor at a pass position between the two ends of the anchor. The filament is preferably capable of passing through the anchor in at least two central passing positions and two longitudinal passing positions. The system may also include an anchor placement device, such as an inserter, anchor driver, or other placement device having a forked or similarly shaped tip configured to effectively position and capture the anchor (as further described below). The anchor is preferably positioned within the forked tip between the two central pass positions for a balanced placement.

According to another aspect, a method for deploying a soft suture anchor structure is provided. The method includes providing a flexible suture anchor and a filament having a first end and a second end. The filament passes through the anchor at a pass position between the two ends of the anchor. Specifically, the filament may pass through at least two central passage positions and two longitudinal passage positions. After the hole in the bone is prepared, the anchor is delivered into the hole by an anchor placement device. The anchor is in a pre-deployment configuration wherein the filament extends a first length between adjacent pass-through positions and the ends of the anchor point in a first direction. The filament can then be tensioned by pulling at least one end of the filament while still on the tip of the anchor driver in the bone hole. As a result of tensioning, the filaments extend a second length between adjacent pass-through positions and the ends of the anchors point in a second direction different from the first direction. The second length is shorter than the first length so that the anchor is changed to the deployed configuration.

As each term is used and described herein, a filament, suture material, or suture may be a single filament and braid (ie, multifilament) suture, as well as any other metallic or non-metallic filament or wire suitable for performing the function of the suture. It may contain mold material. This material may include both bioabsorbable and non-absorbable materials.

As the term is used herein, a suture anchor increases in diameter to a size greater than the size of the bone hole, and thus is deformable to be positioned within the cancellous bone and below the bone cortex of the suture material retained within the preformed bone hole. flexible suture anchors formed from filaments. Some embodiments of such suture anchors and their inherent functionality when deployed within a bone cavity are disclosed in US Patent Publication No. 2012/0290004 assigned to the assignee herein and incorporated herein by reference in its entirety. Because soft anchors are usually made entirely entirely of suture material, they are sometimes referred to as "pre-suture" anchors, and are usually part of the anchor body of a fibrous structure (or in the form of fibers, braids, or fabrics such as flexible meshes, as described in U.S. Patent No. 9173652). structure) and sutures or filaments.

disclosed herein.

BRIEF DESCRIPTION OF THE DRAWINGS The present invention will be more fully understood and appreciated by reading the following detailed description in conjunction with the accompanying drawings. The accompanying drawings show only typical embodiments of the disclosed subject matter and should not be considered as limiting in scope, as the disclosed subject matter may admit to other equally effective embodiments.
Brief reference is now made to the accompanying drawings.
1 is a schematic side view of a flexible suture anchor in a pre-deployment configuration according to an embodiment;
2 is a schematic side view of a flexible suture anchor structure loaded onto an inserter according to an embodiment;
3 is a schematic side view of a flexible anchor structure loaded onto a fully assembled deployment device according to an embodiment;
4 is a schematic side view of a tensioning mechanism of a deployment device with an outer housing removed, according to an embodiment;
5 is a schematic side view of a filament of a flexible suture anchor structure loaded onto a tensioning mechanism of a deployment device according to an embodiment;
6 is a schematic perspective view of a tensioning mechanism of a fully assembled placement device according to an embodiment;
7 is a schematic side view of a flexible suture anchor structure loaded onto an inserter and disposed in a bone hole in accordance with an embodiment.
8 is a schematic side view of a flexible suture anchor structure before deployment and between deployed configurations in accordance with an embodiment.
9 is another schematic side view of a flexible suture anchor structure before deployment and between deployed configurations in accordance with an embodiment.
10 is a schematic final side view of a flexible suture anchor structure before deployment and between deployed configurations in accordance with an embodiment.
11 is a schematic side view of a flexible suture anchor structure in a deployed configuration according to an embodiment.
12 is a schematic side view of a flexible suture anchor structure in a fully deployed configuration according to an embodiment.
13 is a schematic close-up perspective view of a flexible suture anchor structure in a fully deployed configuration according to an embodiment.
14A is a schematic side view of a flexible suture anchor structure in a pre-deployment configuration according to an embodiment.
14B is a schematic side view of the flexible suture anchor structure of FIG. 14A in a deployed configuration according to an embodiment.
14C is a schematic side view of a flexible suture anchor structure in a deployed configuration according to an embodiment.
14D is a schematic side view of the flexible suture anchor structure of FIG. 14C in a deployed configuration according to an embodiment.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS Referring now throughout the drawings in which like reference numbers refer to like parts, a schematic side view of a flexible suture anchor structure 10 according to an embodiment is shown in FIG. 1 . In the illustrated embodiment, the soft suture anchor structure 10 is an anchor 20 having a first end 22 and a second end 24 having a proximal side 26 and a distal side 28 extending therebetween. ) is included. The anchor 20 shown in FIG. 1 is a pre-suture anchor, which may consist of tubular or non-tubular strands of suture. Anchor 20 may also be cylindrical and solid, or have a hollow core, and may or may not be flat (as should be understood by one of ordinary skill in the art upon review of this disclosure). The anterior suture anchor 20 is flexible for anchoring to soft tissue and ultimately positioned to minimize damage to surrounding tissue and bone (as should be understood by one of ordinary skill in the art upon review of the present disclosure).

Anchor 20 is preferably made of polyester suture No. 5, as anchor 20 would ideally remain relatively large and rigid in deployment. Polyester suture No. 5 anchors have a higher weave, so they are denser than typical Y-Knot® anchors, for example. As an additional advantage, the polyester suture anchor No. 5 (20) is less than 50% of the length of a typical Y-Knot® anchor, each 18 mm to 40 mm. As such, Y-Knot® anchors are typically used for bony holes that are 20-24 mm, and the anchor 20 shown in FIG. 1 can be placed in a narrow bone hole that is preferably approximately 10 mm.

Still referring to FIG. 1 , the flexible suture anchor structure 10 also has a passing filament 30 having a first end 32 and a second end 34 woven through the anchor 20 in a T-shape in the pre-deployment configuration. ) is included. If the anchor 20 is thicker than the filament 30 , different combinations of filament 30 and anchor 20 body sizes are possible. In the embodiment shown in Figure 1, anchor 20 is suture 5 and filament 30 is suture 0. The holding force of the No. 5 suture anchor 20 is greater than the tensile force of the No. 0 suture filament 30 woven through it. Thus, when the No. 5 suture anchor 20 is placed within the bone cavity and secured in place and the filament 30 is pulled, the No. 5 suture anchor 30 is preferably removed prior to the proximal movement of the No. 5 suture anchor 20 . will be broken This characteristic of the deployed anchor 20 minimizes creep towards the superior/proximal end of the bony hole. Proximal movement of the anchor 20 placed in the bone hole is undesirable because the bone hole is relatively small and shallow when formed in the limb. Thus, a slight movement of the anchor 20 can completely remove the anchor 20 from the bone cavity. When more tension is applied to the suture 0 filament 30, the suture 5 anchor 20 is configured to widen the bottom of the bone hole to fit into it (the specific placement of the filament through the anchor) , based on its force and position imparted by the placement device on the anchor and the characteristics of the anchor itself). For example, US 2012/0290004 describes the characteristics of certain anterior suture anchors. As described in US 2012/0290004 (eg, shown in paragraphs [0060] and FIGS. 5-6 and also generally shown and described in US 9173652), the soft anchors (or “pre-sutures”) discussed herein Anchor) embodiments may include two sections - at least one filament and fiber structure (anchor body) that may increase in width, thickness and/or diameter and decrease in length as part of the arrangement. Although it is a fibrous structure (anchor) that increases in width, thickness and/or diameter upon placement, it should be understood that filaments also play a role in placement of the anchor. The filament may slide freely (in some embodiments) and remain non-slidable elsewhere (at least at a specific location or point of use) relative to the fibrous structure. In summary, filaments help position, align, and support fibrous structures (anchors). Examples of combinations of anchors 20 through filament 30 include, but are not limited to, anchor number 5 with suture 2 and anchor number 2 with suture 2-0.

1A , the passing filament 30 enters and exits the proximal side 26 and the distal side 28 of the anchor 20 at a plurality of passage locations 36 , 38 . In particular, the filament 30 has two central passage positions having first and second ends 32 , 34 of the filament 30 extending from a central passage position 36 on the distal side 26 of the anchor 20 . (36) and a plurality of longitudinal passage positions (38) are woven through the anchor (20). In the embodiment shown in FIG. 1 , the filaments 30 have a total of 6 with a longitudinal passage position 38 between the first and second ends 22 , 24 of the anchor 20 and a central passage position 36 . It is woven through the anchor 20 at the passing positions 36 and 38 of the dog. However, in other embodiments, the first and second ends 32 , 34 of the filament 30 both extend from the central passage position 36 and the longitudinal passage position 38 is the second of the anchor 20 . The number of pass-through positions 36 and 38 may vary as long as it is between the first and second ends 22 , 24 and the central pass-through position 36 .

Referring to FIG. 2 , there is shown a schematic side view of a flexible suture anchor structure 10 loaded onto an anchor placement device/inserter 40 according to an embodiment. As shown, the inserter 40 includes a forked distal tip 42 having a pair of prongs 44 . The suture anchor structure 10 is loaded onto the inserter 40 such that the anchor 20 is positioned between a pair of prongs 44 on the forked tip 42 . In the configuration shown in FIG. 2 , the suture anchor structure 10 is loaded onto the inserter 40 , such that the distal side 28 of the anchor 20 is positioned distally when placed within the forked tip 42 . However, in an alternative embodiment, the anchor 20 may be loaded between a pair of prongs 44 such that the distal side 28 of the anchor 20 proximally when placed within the forked tip 42 . is located Importantly, the anchor 20 is positioned within the forked tip 42 such that the first end 32 of the filament 30 extends along the first side 46 of the inserter 40 and the second end of the filament An end 34 extends along a second side 48 of the inserter 40 .

Referring now to FIGS. 3-6 , there is shown a schematic side view of a suture anchor structure 10 loaded onto a deployment device 50 according to an embodiment. In summary, FIG. 3 shows a fully assembled deployment device 50 comprising a distal tip having a body extending along a longitudinal y-y axis and having a suture anchor structure 10 positioned on the distal end of the distal tip. show 4 shows the placement device 50 with the outer housing removed to expose the tensioning mechanism 56 . 5 is placement device 50 with the outer housing removed, exposing the tensioning mechanism 56 and showing the first and second ends 32 , 34 of the filament 30 wound around the tensioning mechanism 56 . shows 6 shows the fully assembled positioning device 50 and axial rotation of the gear 58 (shown by the arrows around the gear 58) configured to move the tensioning mechanism 56 proximally.

In some embodiments, an anchor driver or other placement device 50 is used as an alternative to the inserter 40 . Such an anchor driver or other placement device 50 may similarly have a forked tip 52 having a pair of prongs 54 for loading the suture anchor structure 10 . The tensioning mechanism 56 holds the first end 32 and the second end 34 of the filament 30 in tension and at an angle from the longitudinal y-axis (see FIG. 5 ). The first end 32 and the second end 34 of the filament 30 stably wound around the tensioning mechanism 56 maintain the suture anchor structure 10 in the pre-deployment configuration (Figs. 1-3 in Figs. shown) may be inserted into the bony cavity. After insertion of the distal tip into the bone cavity, by tensioning the first end 32 and the second end 23 of the filament 30 of the suture anchor structure 10 (first and second ends in a proximal direction from the distal tip). (by pulling the suture) can be placed to fully extend and set/fix the suture anchor structure 10 inside the bony hole (preferably at the bottom of the hole). For example, a tensioning mechanism 56 may be used to effect this tension. In particular, a knob, crank or other gear 58 may be rotated or driven to proximally pull the first and second ends 32 , 34 of the filament to deploy the suture anchor structure 10 as discussed herein. can be (see FIG. 6). The first and second ends 32 , 34 of the filament 30 may then be released from the placement device 50 , and the placement device may be removed from the surgical site. To further tension the filament 30 and fully extend and set/place the anchor 20 inside the bone cavity, and finalize the procedure as needed (as should be understood by one of ordinary skill in the art upon review of the present disclosure) , first end 32 and second end 34 of filament 30 may further be manually pulled distally away from anchor 20 by a user/medical professional.

The placement of the soft suture anchor structure 10 is further described and illustrated with reference to FIGS. 7-13 . Referring now to FIG. 7 , there is shown a schematic side view of a flexible suture anchor structure 10 implanted by an inserter 40 into a preformed bone hole 60 in accordance with an embodiment. Once the suture anchor structure 10 is loaded onto the inserter 40 (or other placement device 50 ), the inserter 40 pushes the suture anchor structure 10 into the narrow preformed bone hole 60 . is used for the purpose (eg, 10 mm deep). These narrow bone apertures 60 are formed in smaller bones as needed, such as often in the extremities. Bone hole 60 may be formed by known methods and instruments, such as the use of a punch or drill.

When the suture anchor structure 10 enters the narrow bone hole 60 , the first end 22 and the second end 24 of the anchor 20 , due to the narrow width of the bone hole 60 , the bone 62 . begins to fold or bend in a proximal direction towards the surface of the 7 , the first end 22 of the anchor 20 is folded towards the first end 32 of the filament 30 and the first side 46 of the inserter 40 , the anchor The second end 24 of 20 is folded towards the second end 34 of the filament 30 and the second side 48 of the inserter 40 .

After the suture anchor structure 10 is inserted into the preformed bone hole 60 , the suture anchor structure 10 may be deployed. Referring to FIG. 8 , there is shown a schematic side view of a flexible suture anchor structure 10 within a preformed bone hole 60 during deployment. To position the suture anchor structure 10 , the inserter 40 is held in place and fully inserted into the bone cavity 60 , with the first and second ends 32 , 34 of the filament 30 proximal direction is tensioned and pulled away from the anchor 20 . When the first and second ends 32, 34 of the filament 30 are pulled, the length of the anchor 20 between the respective pass-through positions 36, 38 is equal to the length of the filament between the pass-through positions 36, 38 ( 30) are pulled closer together as slack is minimized. On the other hand, as a result, the first end 22 and the second end 24 of the anchor 20 begin to rotate to face the distal direction towards the bottom 64 of the bone hole 60 .

Referring to FIG. 9 , another schematic side view of a flexible suture anchor structure 10 in a preformed bone hole 60 during deployment is shown. To continue deployment of the suture anchor structure 10 , the first and second ends 32 , 34 of the filament 30 are pulled proximally further away from the anchor 20 . When the first and second ends 32 , 34 are pulled, the additional slack of the filament 30 between the pass-through positions 36 , 38 of the anchor 20 is reduced. As a result, the first and second ends 22 , 24 of the anchor 20 continue to fold until the ends 22 , 24 of the anchor 20 face the bottom 64 of the bone hole 60 , or more sharply bent. When the first and second ends 22 , 24 of the anchor 20 are folded, a corrugation 21 begins to form between adjacent pass-through positions 36 , 38 .

Referring to FIG. 10 , there is shown another additional schematic side view of a flexible suture anchor structure 10 in a preformed bone hole 60 during deployment. After the first and second ends 22 , 24 of the anchor 20 are rotated to face the bottom 64 of the bone hole 60 , the first and second ends 32 , 34 of the filament 30 are is pulled much further away from the anchor 20 in the proximal direction. The added tension again shortens the filament 30 between adjacent pass-through positions 36 , 38 at the anchor 20 . As a result, the first and second ends 22 , 24 of the anchor 20 are pulled closer together towards the central longitudinal y-axis through the anchor 20 . As a further result, a corrugation 21 between adjacent pass-through positions 36 , 38 can be further defined.

Thereafter, as shown in FIG. 11 , the first and second ends 32 , 34 of the filament 30 , until no slack remains between the adjacent pass-through positions 36 , 38 of the anchor 20 . pulled In the embodiment shown, the ends 22 , 24 of the anchor 20 face the bottom 64 of the bone hole 60 and are near the central longitudinal y-axis of the anchor 20 . As shown, an anchor 20 with six pass-through positions 36 , 38 has four defined pleats 21 . Applying additional tension to the ends 32 and 34 of the filament 30 causes the anchor 20 to widen or expand within the bone cavity 60 until a fully deployed configuration is reached, as shown in FIG. 12 . By doing so, the anchor 20 is strengthened. In particular, the illustrated embodiment shows that as the anchor 20 is compressed or shortened, the anchor 20 expands in a direction perpendicular to its length (ie, width or thickness) so that it is in place (preferably in bone) in the bone cavity. at or close to the bottom of the hole) shows setting and securing anchors. The corrugation is at adjacent passing locations 36 , 38 from a first distance 31 ( FIG. 1 ) to a second distance 33 relatively shorter than the first distance 31 , as measured along the filament 30 . reduce the distance between

The pleats 21 form a stack of mattress thickness that effectively increases the diameter (as measured with respect to the y-axis of the bone hole 60 and anchor 20 ). This relative magnitude increase in the distance from the y-axis of the bone hole 60 creates a retaining force of the anchor 20 , including the aforementioned expansion in width and/or thickness. In other words, the Poisson's ratio of increasing width and/or mattress thickness while decreasing length provides an increase in batch size in addition to the increase due to corrugation 21 force of anchor 20 . Poisson's ratio defines a causal relationship in which a material tends to expand in a direction perpendicular to the direction of compression and vice versa, a stretched material tends to contract in a direction transverse to the direction of stretching. This ratio defines a proportional decrease in the longitudinal measurement for a proportional increase in length in a sample of elastically stretched material. Thus, for example, if the material is compressed in the x-direction, the material will expand in the y-direction and/or the z-direction. Examples of the use of Poisson's ratio are Figures 7 (showing the suture anchor structure 10 inserted into the bone hole but still in the pre-deployed configuration) and Figure 12 (the suture anchor structure 10 in the deployed configuration). shown) by comparison. Therefore, increasing the number of passing positions 36 and 38 from the 6 shown to more than 7 is likely to increase the number of pleats 21 and thus increase the size of the anchor 20 after placement. . However, the limiting factor is the amount of friction increased by the additional pass positions 36 , 38 . Also, the size of the bone hole 60 is an additional limiting factor.

Referring to FIG. 12 , the suture anchor structure 10 is in a fully deployed configuration with the bone hole 60 and the inserter 40 removed from the suture anchor structure 10 . 13 shows a close-up view of the suture anchor structure 10 outside the bony hole in the deployed state configuration with the filaments 30 extending from the anchor 20 . Referring again to FIG. 12 , the filament 30 is pulled from the anchor 20 by pulling either the first end 32 or the second end 34 until the entire filament 30 is removed from the bone hole 60 . can be removed. The final shape of the anchor 20 in the deployed state allows the filament 30 to easily slide therethrough as the anchor 20 is set and secured to the bone hole 60 . That is, the tensile strength of the anchor 20 of this configuration is sufficient to hold the anchor 20 in place while the filament 30 is easily removed.

While one particular flexible suture anchor structure 10 is shown and further described with respect to FIGS. 1-13 , other embodiments of flexible suture anchor structures 10', 10'' are shown with respect to FIGS. 14A-14D. and has been described. The ability of the anchor 20 to enter or "ball up" into a deployed configuration when the filament 30 is tensioned is in part dependent on the filament 30 along the direction of the longitudinal x-x axis of the anchor 20 . due to at least one change/movement in the direction of The ends 32/34 of the filament 30 do not necessarily pass through the central and/or proximal/proximal ends 22/24 of the anchor to be configured to form such a deployment construction structure. In these described embodiments (in addition to the embodiments described above), preferably all that is necessary is the direction of the longitudinal x--x axis of the anchor 20 , in addition to the pressure provided between the two filament ends. is at least one change in the direction of the filament anywhere along , located on the anchor between the filament ends 32/34, maintaining compression/force in the opposite direction to the pull/tension force of the suture ends 32/34 to position the anchor).

For example, referring to FIG. 14A , a pass-through location 35 near the first anchor end 22 starting at the first filament end 32 and from the proximal side 26 to the distal side 28 of the anchor 20 . ), the filament 30 passing through the anchor 20 is shown. The filament 30 extends in a first direction 43 along an axis parallel to the x-x axis towards the second end 24 . The filament 30 then passes through the anchor 20 near the second end 24 from the distal side 28 to the proximal side 26 at the pass-through position 39 and the second (opposite to the first direction) It continues to extend in two directions (45). Filament 30 anchors at least two times in passage position 41 (proximal side 26 to distal side 28) and in passage position 37 (distal side 28 to proximal side 26). (20) and ends at the second end (34). Measure from the first end 32 to the second end 34 , regardless of how far the filament 30 has passed through the anchor 30 (obliquely relative to the longitudinal x-x axis of the anchor 20 ). As such, there will still be one change/movement in the direction of the filament 30 of FIG. 14A with respect to the longitudinal x--x axis of the anchor 20 . The change/movement in this direction (starting at the starting point of the first direction outside of the anchor at the anchor surface and ending at the end in the first direction outside of the anchor at the same anchor surface, i.e. the distal side/surface ( At position 49 at 28) create at least one slack line 47 . Due to the opposing force of the inserter positioned relative to the anchor 20 between the filament ends 32/34 and pulling the filament ends 32/34 away from the anchor, the anchor ends 22, 24 will be bent in the direction towards the largest slack line (here, towards the slack line 47) as shown in FIG. 14B. With respect to any embodiment, the "largest slack line" is the longest slack line on one side 26/28 of the anchor 20 (single - see FIG. 14A, or addition/combination - see FIG. 14C) . For example, the largest and only suitable slack line in FIG. 14A is slack line 47 , which extends through pass-through location 35 , ends at distal end 28 at point 49 , and at the nearest anchor end. It is created by a filament end 32 extending away from 22 and ending at a point 51 at the beginning of the pass-through position 39 .

Referring to FIG. 14C , two redirection embodiments are shown (two redirection embodiments are also shown with respect to FIGS. 1-13 ). In summary, starting at the first filament end 32 and moving the anchor 20 from the proximal side 26 to the distal side 28 of the anchor 20 at a pass-through position 35 near the first anchor end 22 A passing filament 30 is shown. The filament 30 extends in a first direction 43 along an axis parallel to the x--x axis towards the second end 24 . The filament 30 then passes through the anchor 20 from the distal side 28 to the proximal side 26 at the pass-through position 39 and continues to extend in a second direction 45 (opposite the first direction). . The filament 30 then passes through the anchor 20 at a passage position 41 (from the proximal side 26 to the distal side 28 ) and extends back towards the second anchor end 24 . The filaments 30 continue to extend in a first direction 43 along an axis parallel to the x-x axis towards the second end 24 . Filaments 30 then continue to extend in the proximal direction, passing anchor 20 from distal side 28 to proximal side 26 at passage position 39' and forming second filament end 34 . Measure from the first end 32 to the second end 34 , regardless of how far the filament 30 has passed through the anchor 30 (obliquely relative to the longitudinal x-x axis of the anchor 20 ). As such there will still be two changes/movements in the direction of the filament 30 of FIG. 14C with respect to the longitudinal x--x axis of the anchor 20 . Changes/movements in this direction are created at the two slack lines 47 and 51 (the slack line 47 is the largest since it contains a combination of the two loops). Due to the opposing force of the inserter positioned relative to the anchor 20 between the filament ends 32/34 versus pulling the filament end 32/34 away from the anchor (as described above), the anchor end ( 22, 24 will bend in the direction towards the largest slack line (here, towards the slack line 47) as shown in FIG. 14D.

While embodiments of the invention have been particularly shown and described with reference to specific exemplary embodiments, details without departing from the spirit and scope of the invention as defined by the appended claims, which may be supported by the written description and drawings. It will be understood by those of ordinary skill in the art that various changes may be made therein. Also, where exemplary embodiments are described with reference to a specific number of elements, it will be understood that the exemplary embodiments may be practiced using fewer or more elements.

Claims (13)

a pre-suture anchor extending along a longitudinal axis having two ends positioned in a first direction in a pre-deployment configuration;
the two ends are positioned in a second direction different from the first direction in the arranged configuration;
Further comprising a filament woven through the pre-suture anchor at a plurality of passage locations,
wherein the filament has two ends, at least one of which extends from a first pass-through position proximate to one of the two ends of the pre-suture anchor.
According to claim 1,
and the other end of the filament extends from a second passage location adjacent the first passage location.
3. The method of claim 2,
wherein the filaments change direction at least once along the direction of the longitudinal axis.
4. The method of claim 3,
wherein the filament passes from a third pass position proximate to the center of the pre-suture anchor and a fourth pass position at the other of the two ends of the pre-suture anchor from an end proximate the first pass position.
5. The method of claim 4,
and the filaments extend through the fourth pass-through location from an end passing through the first pass-through location to define a slack line having a first length therebetween.
6. The method of claim 5,
wherein the filaments extend from the fourth passage position to the third passage position to define a second slack line having a second length that is shorter than the first length.
7. The method of claim 6,
and the filaments extend from the third pass-through location to the second pass-through location.
According to claim 1,
and the other end of the filament extends from a second pass-through location adjacent the other of the two ends of the pre-suture anchor.
9. The method of claim 8,
wherein the filaments change direction at least twice along the direction of the longitudinal axis.
10. The method of claim 9,
wherein the filament passes through a third pass-through location on the first side of the pre-suture anchor proximate to the first pass-through position and a fourth pass-through location on the opposite side of the pre-suture anchor proximate to the second pass-through position. .
11. The method of claim 10,
and the filaments extend through the fourth pass-through location from an end passing through the first pass-through location to define a slack line having a first length therebetween.
12. The method of claim 11,
wherein the filaments extend from the fourth passage position to the third passage position to define a second slack line having a second length that is shorter than the first length.
13. The method of claim 12,
wherein the filaments extend from the third passage location to the second passage location to define a third slack line having a third length equal to the first length.

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